Dont forget pethidine is capable of exerting effects at other receptor
sites also, the most conseqential of which are serotonin effects.
Pethidine induced excessive release of pre-synaptic serotonin may produce
the srotonin syndrome whic is freqently underdiagnosed in emergency
departments. (Andy Stearman's - on the list - and Andis Graudin's
publication in Annals is testament to this). The syndrome of muscle
rigidity, hyperthermia and altered mental status is probably underdiagnosed
particularly among the elderly. This effect is not seen with morphine or
fentanyl. Another good reson for not using pethidine ?
And if you do get seizures from accumulation of active hepatc metabolites
they are unresponsive to naloxone which may in fact potentiate seizures.
John Ryan
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